The uninsured rate among American adults 18 and older has declined more significantly this year in states that chose to both expand Medicaid and set up their own Obamacare exchanges than in states that decided not to, Gallup said.
On average, the rate dropped 2.5 percent points in the 21 states — plus Washington, D.C. — that implemented both pillars of the Affordable Care Act, compared to a 0.8-point decrease in the 29 states that rejected one or both options.
Gallup said the states that chose to expand Medicaid and set up their own private insurance portals had a lower average uninsured rate to begin with, at 16.1 percent compared to 18.7 in the other states. That gap widened to 4.3 percentage points in the first quarter of 2014.
"While a majority of Americans continue to disapprove of the Affordable Care Act, also known as 'Obamacare,' the uninsured rate appears to be declining, as the law intended," Gallup reported.
The survey is sure to buoy President Obama's supporters, but critics of the law say his signature health care law has many flaws.
Much of the coverage is partly or fully subsidized by taxpayer dollars, they have noted, and new enrollees might find their out-of-pocket costs too high to make their new coverage work for them.
Gallup's tally of states that embraced the overhaul's reforms includes states that entered "partnership" exchanges with the federal government.
Two states, Idaho and New Mexico, set up their own state exchanges but relied on the federal HealthCare.gov site during the first year of enrollment. It does not appear that Gallup included them in their state-exchange tally for 2014 and the results of its new survey.
Only four states — North Dakota, New Jersey, Ohio and Arizona — decided to expand Medicaid but deferred the complete administration of their exchange to the federal government.
Five states — Indiana, Missouri, Pennsylvania, Utah and Virginia — are openly debating whether to expand Medicaid, said the nonpartisan Kaiser Family Foundation, which studies health policy.
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